Healthcare Provider Details

I. General information

NPI: 1902463904
Provider Name (Legal Business Name): PATHWAY MEDICAL SOLUTIONS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2019
Last Update Date: 05/30/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

416 ROSWELL ST SE
MARIETTA GA
30060-2067
US

IV. Provider business mailing address

416 ROSWELL ST SE
MARIETTA GA
30060-2067
US

V. Phone/Fax

Practice location:
  • Phone: 678-674-7311
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: MR. MILES NEAL
Title or Position: CEO
Credential:
Phone: 678-674-7311